Provider Demographics
NPI:1902361033
Name:KIRKPATRICK, JENNIFER T (LCMHC, ATR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:LCMHC, ATR
Other - Prefix:
Other - First Name:JEN
Other - Middle Name:
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC, ATR
Mailing Address - Street 1:4109 WALLINGFORD PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5538
Mailing Address - Country:US
Mailing Address - Phone:919-597-1030
Mailing Address - Fax:
Practice Address - Street 1:727 EASTOWNE DR STE 300B
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2209
Practice Address - Country:US
Practice Address - Phone:919-597-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-03
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17-063221700000X
NC13268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist